title: Bradycardia seen in children with Crimean-Congo hemorrhagic fever.
abstract: BACKGROUND
  Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy.
  
  
  METHODS
  Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age.
  
  
  RESULTS
  Fifty-two patients (mean age 11.2 ± 4.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 ± 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively).
  
  
  CONCLUSIONS
  Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.
authors.affiliation: 1 Pediatrics Department, Cumhuriyet University Medical School , Sivas, Turkey .
authors.forename: Mehmet Burhan
authors.initials: MB
authors.lastname: Oflaz
authors.forename: Zekeriya
authors.initials: Z
authors.lastname: Kucukdurmaz
authors.forename: A Sami
authors.initials: AS
authors.lastname: Guven
authors.forename: Hekim
authors.initials: H
authors.lastname: Karapinar
authors.forename: Ali
authors.initials: A
authors.lastname: Kaya
authors.forename: Enver
authors.initials: E
authors.lastname: Sancakdar
authors.forename: Koksal
authors.initials: K
authors.lastname: Deveci
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Gul
authors.forename: Alim
authors.initials: A
authors.lastname: Erdem
authors.forename: Omer
authors.initials: O
authors.lastname: Cevit
authors.forename: F Dilara
authors.initials: FD
authors.lastname: Icagasioglu
mesh_terms: D000293:Adolescent; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D001919:Bradycardia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D003225:Hemorrhagic Fever Virus, Crimean-Congo / Q000276:immunology*; D006479:Hemorrhagic Fever, Crimean / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D064927:Tick Bites; D014421:Turkey / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral